St. Joseph plans to save money, increase care by reaching out to frequent ER users; county receives grant for neediest patients

Humboldt County has received a grant to help find more efficient ways of treating "super-utilizers," patients that use costly emergency room services numerous times a year, but often don't receive the long-term treatment needed to address their underlying medical issues.

"These are people the health care system has given up on," said Jeffrey Brenner, executive director of Camden Coalition of Healthcare Providers, who recently spoke at St. Joseph Hospital about his work in developing more efficient, lower-cost health care.

The county's current program, which focuses on super-utilizers, is one of six alliances around the U.S. to receive the two-year, $200,000 grant from the Robert Wood Johnson Foundation, the country's largest philanthropic foundation for health care.

The program -- collectively known as Aligning Forces Humboldt -- is a collaboration of several local health organizations that share records and streamline care for frequent patients.

St. Joseph officials say they plan to find the right care for super-utilizer patients while reducing pricey emergency room visits.

Sharon Hunter, St. Joseph Care Transitions program manager, said she wants to apply some of Brenner's ideas for super-utilizers here.

"We want to measure our success not only with more quality care, but also with reduced cost," she said.

Hunter said, as an example, one local woman who used the St. Joseph ER 21 times in four months, largely due to pain issues and anxiety, and a heart attack.

"It was the easiest, most convenient way for her to get care," Hunter said.

The woman's visits left St. Joseph with $80,000 in unreimbursed hospital bills.

Hunter said she worked with her to coordinate more visits with the Eureka Community Health Center, where she was a patient, and with mental health professionals, to meet or prevent some of her chronic issues before she needed to go to the ER.

With the individualized attention, Hunter said the woman's quality of care went up while her unreimbursed ER bills for St. Joseph plummeted to less than $1,000.

The difference is "focused case management," Hunter said, a path she plans to continue with patients using the grant money.

Brenner is somewhat famous for pioneering a data and map-based approach to tackling the super-utilizer issue. He was the focus of a 2011 New Yorker story, which praised his ingenuity of taking hospital records, mapping them, and looking for the health "hot spots" around his hometown of Camden, N.J. -- the places with the most health risks, and likely the highest number of needy ER super-utilizers.

He found a man, much like the Eureka woman Hunter helped, that had a slew of health issues and was "simply another hospitalization waiting to happen," according to the New Yorker story. Brenner talked with him, tracked his activities, and figured out new care strategies so he wouldn't just end up back in the ER.

Brenner had a social worker help the man apply for disability insurance, and a nurse practitioner that made occasional visits to check the man's blood-sugar levels and blood pressure at home. He used various resources to try and help break the man's addictions to alcohol, smoking, and cocaine.

Eventually, he was able to help get care for more than 300 similar super-utilizers in Camden.

"Our medical community has really rolled our eyes at these folks," Brenner said. "These people can be our teachers to figure out how to fix care for everyone."

Brenner said he was particularly excited to speak at St. Joseph because Humboldt County is small and rural. He said he thought the county could have an easier time creating a successful super-utilizer program than big cities like his hometown Camden, or Cleveland or Cincinnati, cities that also received grants.

"Patients get lost," in big cities' health care systems, Brenner said. "Patients sometimes touch four or five entities. Sometimes these places in the middle of nowhere better collaborate between institutions."

Hunter agreed.

"Our goal is really about accessing care at the right place, at the right time," she said.